House of Lords, please kill the Health and Care Bill before it kills us!

It’s the House of Lords’ turn to debate and vote on the Amended Health and Care Bill that MPs approved at the Bill’s third reading in the House of Commons last month.

Here is the Health and Care Bill briefing we have prepared for the House of Lords’ Second Reading of the Bill. You are welcome to send it to any member you think will be interested in it.

The debate will start at 2.30pm on 7th December. Over 80 members are expected to speak, including Baroness Natalie Bennett.

Because we have a bit of a connection with her from when she visited the Ban the Burn campaign in Hebden Bridge following the 2015 Boxing Day floods, Calderdale and Kirklees 999 Call for the NHS have written to Baroness Bennett asking her to speak out against the Bill during the debate and to vote against it, because no amendments can make it fit for the 21st century NHS.

Here is what we have asked her.

In the Third Reading debate, please will you draw attention to the fundamental misconception at the heart of the Health and Care Bill?

Despite more than a decade of NHS and social care integration schemes, there is no evidence that the integration and innovation measures that the Bill aims to put on a statutory basis have done anything to improve the quality and sustainability of NHS services, patient outcomes and population health.

This is only one of four main problems with the Health and Care Bill, which seems most likely to perpetuate the government’s managed decline of the NHS:

  • The Bill reduces the government’s obligations to secure healthcare for us all
  • The Bill will worsen the current healthcare staff shortage, by deregulating clinical professions and legislating for staff passporting schemes introduced during the pandemic. By forcing NHS staff to work outside the roles they trained for, and outside the safety and efficiency of their established teams, this has caused moral injury to staff. If this goes on, they will vote with their feet.
  • The Bill is designed for big business – putting big business at the heart of decision-making about the provision of the country’s healthcare and delivery of services
  • The Bill will do nothing to solve the NHS’s problems and no amount of amendments will change that

Even the Conservative think tank The Centre for Policy Studies has recommended that the Government should:

“ Drop from the Health and Care Bill legislation to put ICSs on a statutory footing.”

This advice is based on their report on the impact of two of the most advanced Integrated Care Systems, Greater Manchester and West Yorkshire, which found no evidence that they had achieved their objectives.

Please will you also vote against the Bill, given that there seem to be no possible amendments that could make it fit for the 21st century NHS?

Amendments can only limit the damage this Bill would do, since it is fundamentally so destructive of the principles of a publicly owned, funded and provided, comprehensive NHS that provides the full range of healthcare for those who have a clinical need for it.

If this Bill is passed into law, the likely result would be an even more broken, disjointed and expensive profit-driven two tier public/private healthcare service than at present.  This is relevant to one of the headline topics for tomorrow’s debate in the House of Lords: the impact of reorganising the NHS while it is still dealing with the effects of the COVID-19 pandemic

In connection with another of the headline topics – involvement of private healthcare companies and transparency of awarding contracts under a new procurement regime – please also draw attention to the remarkable permissiveness of The Health and Care Bill and its unspoken reliance on Department of Health and Social Care secondary legislation, once Parliament has passed the Health and Care Bill into law.

As you will know, two cross-party House of Lords Select Committees have criticised this practice as  “government by diktat” and “a tendency in departments to introduce bills before the underlying policy has been thoroughly thought through.”

One effect of the Health and Care Bill’s laxness would be to secretively permit private and third sector companies to have decision making powers about NHS and social care commissioning, through their membership of various bodies (including Provider Collaboratives) that have powers delegated from Integrated Care Boards.

This is clear from NHS England’s guidance that Integrated Care Boards’ constitutions should include arrangements for delegation of the Board’s functions and powers, on the understanding that this will be covered by the Department of Health and Social Care’s secondary legislation once Parliament has passed the Health and Care Bill into law.

This makes a mockery of the government’s amendment that would prevent private companies from membership of Integrated Care Boards.

Since the Health and Care Bill is fundamentally misconceived, damaging to staff and patients, and dangerously sketchy in ways that privilege private company interests, please make the case in the House of Lords that any health and social care legislation must be deferred until a Bill can be drafted that will enable:

  • world class health care for all
  • a national publicly provided health service, adequately publicly funded and free at the point of need
  • a comprehensive service providing treatments based on the patient’s best interest, decided together with clinicians not on the basis of financial ‘risk stratification’ calculations
  • A strong workforce with national pay and conditions and professions regulated independently of government politics.

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